Drug found effective for child's anxiety

Study likely to raise issues about using psychiatric medicine

April 26, 2001|By Jonathan Bor | Jonathan Bor,SUN STAFF

Anxious children can benefit from a medication that is often prescribed for depression and other mental disorders, according to a new study that's likely to stir debate over the use of psychiatric drugs in youngsters.

Researchers at the Johns Hopkins School of Medicine say the drug helped children who were afraid to sleep alone, attend school or make friends, or who worried needlessly that terrible things would happen to them or their parents.

After eight weeks of treatment, doctors say, substantial numbers of children slept better, began socializing and performed better in school because they worried less.

The study, reported in today's New England Journal of Medicine, was the first large-scale trial of a medication to treat anxiety in children.

Dr. John Walkup, a Johns Hopkins psychiatrist involved in the study, said yesterday that findings do not mean doctors should immediately consider the drug - Luvox - for extremely worried children.

Further research is needed to decide how the medication compares with talk therapy or whether the two should be used together, he said.

Studies have shown that cognitive therapy, a method that helps patients to change distorted patterns of thinking, is effective in reducing anxiety in both children and adults. But there have been no studies comparing such nondrug approaches and drugs in the treatment of anxious children.

At minimum, said Walkup, the study shows that severe anxiety should not be dismissed as a normal feature of childhood and that treatment can be beneficial.

"If kids are worried, fearful or anxious, we shouldn't think of those symptoms as benign," said Walkup, the principal investigator along with Dr. Mark Riddle, also of Johns Hopkins. "They should raise suspicions and concerns, and parents should talk to a pediatrician or mental health professional."

Leading to later problems

Walkup said that untreated anxiety can lead to severe depression and other problems in adulthood.

Luvox belongs to a family of medications that elevate mood by making the brain chemical, serotonin, more available to nerve receptors. The drugs include the popular antidepressants Prozac, Zoloft and Paxil.

Luvox has much the same effect on the brain as the antidepressants and is prescribed to treat depression in children and adults. For marketing reasons, however, the drug was introduced as a treatment for obsessive compulsive disorder, a mental disease in which patients engage in repetitive behaviors such as cleaning, counting and hand washing.

Hopkins' participation

The new study was carried out at Hopkins, Duke and Columbia universities, New York State Psychiatric Institution and New York University. Together, the centers are being funded by the federal government and pharmaceutical industry to evaluate the safety and effectiveness of psychiatric drugs on children.

Many of the drugs under study are being prescribed widely for children even though they have been tested only on adults. Others are being used for psychiatric disorders other than the ones included in the labeling approved by the U.S. Food and Drug Administration.

Such off-label uses are legal but have raised concerns about whether patients are being helped or hurt.

Little is known about the effects of psychiatric medications on the developing brain. Last year, a United Nations panel assailed the United States for overprescribing psychiatric drugs - in effect, for "medicalizing" social problems.

In an editorial accompanying today's article, Dr. Joseph Coyle of Harvard Medical School said the study leaves many questions unanswered, such as how long children should be treated and what is the role of psychotherapy.

In the study, researchers recruited 128 children ages 6 to 17 who were diagnosed with one of three anxiety disorders: social phobia, separation anxiety and generalized anxiety. Children were excluded from the study if they were suffering from depression.

`Looked forward to school'

The children were randomly selected to receive Luvox or a placebo. After eight weeks, according to the study, 76 percent of the children receiving the drug showed substantial improvement, compared with 29 percent of those receiving the placebo.

"Especially in younger kids, when the anxiety was gone they began to do things they never did before," said Walkup. "They looked forward to school rather than worried about it."

The most common side effects were headache, abdominal pain and hyperactivity. In most cases, Walkup said, symptoms subsided when the dose was reduced.